原发性心脏肿瘤的外科手术策略探讨

Surgical strategy for patients with primary cardiac tumors

目的总结外科手术治疗原发性心脏肿瘤的临床经验,探讨手术策略,并评价其安全性和疗效。方法2012年4月至2019年12月,109例原发性心脏肿瘤患者在四川省人民医院心脏外科中心,通过前正中胸骨全切开、胸骨下段部分切开以及胸腔镜三种方式进行外科手术治疗,对围术期及随访期的临床资料进行总结分析,评价手术安全性和效果。结果93例患者采用胸骨全切开为肠骨全切开组;3例患者采用胸骨下段部分切开及13例患者采用胸腔镜手术为微创组,合计16例。108例患者在体外循环下行肿瘤根治术,1例左心室恶性肿瘤患者仅行剖胸活检术。全组手术时间(229.04±62.24)min,体外循环时间(84.47±46.79)min,主动脉阻断时间(46.97±34.93)min,术后呼吸机辅助时间(14.95±57.90)h,术后监护室停留时间(43.24±69.79)h。全组术后并发低心排4例,肺部感染3例,右侧气胸1例,胸部切口愈合不良1例。微创组的体外循环时间虽长于胸骨全切开组,但术后住院时间短于胸骨全切开组(P<0.05)。术后病理证实107例为心脏黏液瘤,2例为心脏肉瘤。106例患者随访(46.37±25.12)个月,3例死亡,1例左心房黏液瘤患者术后3个月死于重症肺部感染,2例心脏肉瘤患者分别于术后11个月和13个月死于肿瘤转移。结论外科手术治疗原发性心脏肿瘤是安全的,且近中期疗效满意,部分患者可采用胸骨下段部分切开或胸腔镜方式进行微创手术治疗。

Objective To summarize the clinical experience of surgical treatment for patients with primary cardiac tumor to explore the surgical strategy and its safety and efficacy.Methods From April 2012 to December 2019,109 patients with primary cardiac tumor received surgical treatment[total anterior median sternotomy(total sternotomy group),partial sternotomy and thoracoscopy(minimally invasive group)]in Cardiac Surgery Center of Sichuan Provincial People s Hospital.The clinical data in perioperative period and during follow-up period were summarized and analyzed to evaluate the operation safety and efficacy.Results Ninety-three patients underwent total sternotomy(total sternotomy group),3 patients received partial lower sternotomy and 13 patients underwent thoracoscopic surgery(minimally invasive group,n=16).The radical operation with cardiopulmonary bypass was performed on 108 patients,and thoracotomy biopsy was conducted on one patient with left ventricular malignant tumor.The average operation time was(229.04±62.24)min,the cardiopulmonary bypass time was(84.47±46.79)min,the aortic cross-clamp time was(46.97±34.93)min,the postoperative ventilator support time was(14.95±57.90)hours and the postoperative ICU stay time was(43.24±69.79)hours.Postoperative complications included low cardiac output in 4 cases,pulmonary infection in 3 cases,right pneumothorax in 1 case and poor healing of incision in 1 case.The cardiopulmonary bypass time in minimally invasive group was longer than that in total sternotomy group,but the postoperative hospital stay was statistically shorter than that in total sternotomy group(P<0.05).There were 107 cases of cardiac myxoma and 2 cases of cardiac sarcoma confirmed by postoperative pathology.During a mean(46.37±25.12)months follow-up period,one patient with left atrial myxoma died of severe pulmonary infection 3 months after operation,and two patients with cardiac sarcoma died of tumor metastasis at 11 and 13 months after operation,respectively.Conclusion Surgical treatment of primary cardiac tumors is safe,and the curative effect is satisfactory in the near and medium term.Minimally invasive surgery by partial incision of the lower sternum or thoracoscopy can be conducted on some patients.